The Hematologic Malignancies Section at New York Presbyterian Hospital/Columbia University Medical Center is committed to exceptional patient care and the continued advancement of the treatment of leukemia and other blood cancers.
What is Leukemia?
Leukemia is a cancer of the blood and blood cells. Blood is made of three types of cells:
- White blood cells that fight infection,
- Red blood cells that carry oxygen from the lungs to the rest of the body, and
- Platelets that help the blood clot and stop bleeding.
These cells are made in the bone marrow, a spongy area in the center of the bones. Once these cells mature, they leave the bone marrow and circulate in the bloodstream.
In the case of leukemia, the bone marrow begins to produce a single type of blood cell (usually an abnormal white blood cell) in large numbers. Typically, these abnormal cells look different than the healthy cells under the microscope and do not work normally. They crowd the bone marrow so that healthy cells cannot be made.
What are the Types of Leukemia?
Leukemias are classified by: (1) how quickly they progress and (2) the type of cell that is affected. In acute leukemia, immature white blood cells, known as blasts, grow rapidly. This can cause severe symptoms in a short time. In chronic leukemia, the abnormal cells grow more slowly. This form of leukemia is often found on a routine physical exam or blood work.
Leukemia can affect two types of cells:
- Myeloid leukemias develop in white blood cells known as neutrophils and monocytes. Normal neutrophils and monocytes are important in fighting bacterial or fungal infections. In myeloid leukemia, the body makes abnormally functioning copies of these cells.
- Lymphocytic leukemias develop in B lymphocytes, T lymphocytes, or natural killer (NK) cells. Normally, these cells produce antibodies or other substances that fight infections.
There are four main types of leukemia:
- Acute myeloid leukemia (also called AML), which occurs in both children and adults.
- Acute lymphoblastic leukemia (ALL), which is the most common type seen in children but can also be seen in adults, especially over age 65.
- Chronic myeloid leukemia (CML), which is seen mostly in adults
- Chronic lymphocytic leukemia (CLL), which is the most common leukemia in adults but is almost never seen in children.
What are the Signs of Leukemia?
As the number of abnormal leukemia cells increases in the bone marrow, the production of healthy infection fighting white blood cells goes down. This can cause the body to have difficulty fighting off infections, leading to fever and infections that do not go away. The leukemia cells in the bone marrow can also stop the production of other normal blood cells. Patients can develop a low red blood cell count, known as anemia. This can cause the person to feel tired or short of breath and to look pale. Low platelet counts can put people at risk for easy bruising or bleeding.
Common symptoms of leukemia include: fever, chills, weakness, fatigue, swollen or tender lymph nodes, increased size of the liver or spleen, easy bleeding or bruising, swollen or bleeding gums, night sweats, weight loss, and bone or joint pain. In acute leukemia, the abnormal cells can sometimes grow in or around the brain and spinal cord, causing headaches, blurred vision, double vision, vomiting, or confusion.
How is Leukemia Diagnosed?
The healthcare provider will ask about the patient’s medical history and perform a physical exam. Sometimes an enlarged spleen, liver, or lymph nodes might be found. A laboratory test called a complete blood count is done to check for leukemia cells in the blood. We can also see if other blood cells are being made normally.
In many cases, the healthcare provider will need to take a sample of the bone marrow to see what type of leukemia the patient has. This is done by numbing the area well with lidocaine and inserting a needle into a bone (usually the back of the hip) and removing a sample of the marrow. The marrow cells are looked at under a microscope and tested for certain genetic changes. In some forms of leukemia, it may also be necessary to perform a lumbar puncture (spinal tap) to see if there are leukemia cells in the nervous system.
How is Leukemia Treated?
Treatment depends on the type of leukemia. It can differ based on the patient’s age, overall health, and extent of disease. There are about 45,000 cases of leukemia diagnosed each year in the United States. Since it is a relatively rare, patients should be treated at a medical center with expertise in the disease.
Acute leukemias should be treated quickly. The goal of treatment is to rid the body of leukemia cells and restore production of normal blood cells. This is known as remission. Once the patient is in remission, additional treatment is usually needed to prevent the disease from coming back. In some cases, doctors will recommend stem cell transplantation (See Blood and Marrow Transplantation). Chronic myeloid leukemia (CML) is usually treated with medications taken in pill form. Chronic lymphocytic leukemia (CLL) may not need to be treated right away. Treatment may become necessary in the future if symptoms develop or the leukemia interferes with the production of normal blood cells.
More details regarding the treatment of leukemia can be found at the Leukemia & Lymphoma Society Web site: http://www.lls.org.
Advances in the treatment of leukemia can be made only through innovative clinical trials. The faculty at Columbia University Medical Center is committed to finding safer and more effective treatments. Currently, our physicians are focusing on:
- Early development of new drugs, with a special interest in small molecule inhibitors of cell cycle regulated kinases.
- Use of targeted radiotherapy using monoclonal antibodies.
- Development of novel combination therapies that include chemotherapy, immunotherapy, and small molecule inhibitors.
To search for clinical trials at Columbia University Medical Center, please go to www.clinicaltrials.gov.
Rare Types of Leukemia and Other Blood Cell Cancers
Although leukemias are less common than many other types of cancer, some cancers of the blood cells are seen even less often. These diseases may occur in fewer than 5,000 patients per year in the United States. Physicians in the Hematologic Malignancies section have dedicated research interest in such diseases as myelofibrosis and the related diseases of polycythemia vera and essential thrombocythemia (also known as essential thrombocytosis). Our physicians also have experience and expertise in treating even rarer blood diseases such as hairy cell leukemia, large granular lymphocytic leukemia, adult acute T-cell leukemia/lymphoma (ATLL), systemic mastocytosis, hypereosinophilic syndrome, adult Langerhans cell histiocytosis, Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) and Erdheim-Chester disease.
See the list below to learn more about our leukemia physicians, their education, training, and areas of clinical expertise. These physicians work closely with faculty from Blood & Marrow Stem Cell Transplantation, the Myelodysplastic Syndrome (MDS) Center, and the Center for Lymphoid Malignancies to develop a treatment plan that is right for each patient.
- Joseph G. Jurcic, M.D.
Director, Hematologic Malignancies Section
Professor of Clinical Medicine
- Mark G. Frattini, M.D., Ph.D.
Director of Research, Hematologic Malignancies Section
Associate Professor of Clinical Medicine
- Markus Y. Mapara, M.D., Ph.D.
Director, Blood and Marrow Transplantation Program
Associate Professor of Medicine
- Owen A. O’Connor, M.D., Ph.D.
Director, Center for Lymphoid Malignancies
Professor of Medicine and Developmental Therapeutics
- David Diuguid, M.D.,
Director, Hematology Section
Associate Professor of Clinical Medicine & Clinical Pathology
- Andrew Eisenberger, M.D.
Assistant Professor of Clinical Medicine
- Mark Heaney, M.D., Ph.D.
Associate Clinical Professor of Medicine
- Nicole Lamanna, M.D.
Associate Clinical Professor of Medicine
- Todd L. Rosenblat, M.D.
Assistant Clinical Professor of Medicine
- Christina Baldwin, N.P.
- Desiree Sanchez, R.N.
- Kevin Zikaras, Clinical Research Coordinator
- Hanna Weissbrot, Clinical Research Coordinator
For an appointment with one of our outstanding physicians, call 212-305-5098, Monday – Friday, 9:00 AM – 5:00 PM.